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Background: Research has focused on male clients of female sex workers (FSWs) and their risk for HIV/sexually transmitted infections (STIs). However, it is unclear whether the commercial sex behaviors of these men are limited to paying for sex or whether they may also be paid for sex themselves.

Methods: We analyzed the interview data and HIV/STI test results from 170 drug-using male clients of FSWs in Tijuana, Mexico, to determine the extent to which these men report being paid for sex and the association with positive HIV/STI results.

Results: More than one quarter of men reported having been paid for sex in the past 4 months. In a multivariate logistic regression model, reporting having been paid for sex was significantly associated with testing positive for any HIV/STI (adjusted odds ratio [AdjOR], 3.53; 95% confidence interval [CI], 1.33–9.35), being bisexual (AdjOR, 15.59; 95% CI, 4.81–50.53), injection drug use in the past 4 months (AdjOR, 2.65; 95% CI, 1.16–6.03), and cocaine use in the past 4 months (AdjOR, 2.93; 95% CI, 1.22–7.01).

In a study of drug-using male clients of female sex workers, 26.5% reported also having been paid for sex. HIV/sexually transmitted infection–positive clients were 3.5 times as likely to have been paid for sex as HIV/sexually transmitted infection–negative clients.

From the *Division of Global Public Health, Department of Medicine, and †Department of Psychiatry, University of California San Diego, La Jolla, CA; and ‡Centro de Investigación en Infecciones de Transmisión Sexual, Programa de Investigación de la Clínica Especializada Condesa Programa de SIDA de la Ciudad de México Secretaría de Salud del Distrito Federal, México DF, México

Acknowledgments: The authors thank the project staff who assisted in the data collection effort (Arturo Tornez Zamudio, Deyna Arellano, Alfonso Chavez Rivera, and Ma. De Los Angeles Ramirez) and the participants who shared their stories for this account.

Supported by the US National Institutes of Health (K01DA031031, R01DA029008, T32DA023356). The funders had no further role in the design or conduct of the study and in the decision to submit the manuscript for publication.

Conflict of interest: None declared.

Contributors: K.D.W. was responsible for the design of the study, data analysis, and drafting the final manuscript. E.V.P. contributed to the conceptualization of the analysis and preparation of the manuscript. C.V.C. was responsible for overseeing the data collection and contributed to the preparation of the manuscript. C.M.-R. provided guidance on the presentation of results. T.L.P. contributed to the design of the study, conceptualization of the analysis, and presentation of the results.